Cardiac Rehab: Boosting Your Heart Recovery

If you've recently had a heart attack, or you're recovering from surgery such as heart bypass or stent placement -- or you have a condition such as hardening of the arteries, angina or heart failure -- you should ask your doctor about cardiac rehabilitation.

Cardiac rehab is proven to reduce your risk of future heart episodes. It offers a safe, medically supervised way to gradually build your activity tolerance. Programs take place in specialized exercise facilities within the hospital, and you wear a heart monitor while you work out. The rehabilitation team includes doctors, nurses, exercise physiologists, dietitians and others.

Insurance covers cardiac rehab, which typically lasts 36 sessions. Patients attend several times a week, and many programs offer a variety of classes and speakers on topics from diet to smoking cessation to stress reduction. People who've completed cardiac rehab say they once again feel normal, whole and energized -- ready to reclaim their family, work and social lives. So what are you waiting for?

Starting Slow

When people enroll in the cardiac rehabilitation program at the Howard University Hospital Heart Center, they may feel hesitant at first -- especially if they had experienced severe chest pain, says Dr. Otelio Randall, cardiologist and program director. But fear fades, he says, because "we are right there with them, and they start off at a very low level of exercise."

Before patients start, the rehab team evaluates their EKG and echocardiogram results and looks over recordings from ambulatory blood pressure monitors. As patients build their activity tolerance, an exercise physiologist monitors them every step of the way.

Patients start off on the treadmill. "They're on a monitor, and the treadmill might go like 2 miles an hour," Randall says, "and then we just gradually go up until we get them to what they should be able to do." On recumbent bicycles, patients pick their own speeds, and the team sees how their hearts respond. "For instance, if the heart rate goes up too much, we'll have them to do a lower load for a shorter period of time," he says.

If symptoms arise during exercise, the rehab team is prepared. "If it looks like there's anything that might progress to cardiac arrest or arrhythmias, obviously, we would stop the patient," Randall says. "But that hardly ever happens." While a few patients may need repeat heart studies or procedures, most are able to complete program.

More Than Just Exercise

During cardiac rehab, patients learn how their heart medications interact with exercise. That could mean "deciding whether they can exercise safely on a beta-blocker [a blood-pressure drug] that might keep their heart rate from increasing," Randall says. Diet education is a big part of Howard's program -- Randall has published studies on the diet he created several years ago. He considers it a "universal diet" because it reduces risk factors for high blood pressure, diabetes, obesity and, of course, heart disease.

Life doesn't have to change forever after a heart episode, Randall says. "You can recover a lot of your activity if you go through a program that's designed to build your muscles and evaluate what you're capable of doing."

'I Want to Go to Rehab'

After her 2008 heart attack, Carolyn Thomas didn't feel like herself. "I heard about this cardiac rehab and thought, 'Whoa, that's what I need,'" she says. "Because I knew that I had undergone this completely traumatic emotional and physical event."

Supervised exercise was the draw for Thomas, who had always been extremely active. But now she felt feeble and fearful. "Little twinges and tweaks had me clutching my chest thinking, 'Uh-oh, is it something? Is it nothing? Should I call 911?'" And she was taken aback by her limited activity tolerance; she couldn't walk around the block without leaning on her son's arm for support.

Cardiac rehab was "completely about confidence," she says. "There was a difference between the old, sick person who kind of tiptoed into the first rehab class and the person who finished."

Great Programs/Big Attendance Gap

Research is clear: Heart patients do better after cardiac rehabilitation. A 2010 study in the journal Circulation found that heart disease patients who completed 36 sessions had reduced risk of heart attack and death within the next four years, compared with those who did fewer sessions. A 2013 study from the American College of Cardiology found that women with coronary artery disease who completed a 12-week program were two-thirds less likely to die during the 15-year study time frame than those who weren't referred to cardiac rehab.

Many doctors fail to refer eligible patients, research shows, and that's a big problem. Only about 20 percent of patients who should receive cardiac rehab actually do, studies show. Access is another issue. Many people, particularly women, may be reluctant to take time away from work and family to attend.

Randall says he's not sure what keeps people away, but lack of awareness may be a factor. "Rehab is not a big moneymaking business," he says. "That might have something to do with it." But if doctors emphasize the benefits, he says, "Most patients will come -- and they'll like it and come back."

Thomas, who founded the widely followed Heart Sisters blog, just ran an informal survey to learn whether the name "cardiac rehabilitation" was a turnoff to readers (it wasn't). One reader described the programs as "long-term life insurance."

Above and Beyond

Dr. James Beckerman, medical director of the cardiac rehabilitation program at the Providence Heart and Vascular Institute, could be describing your local gym: "We have treadmills, elliptical machines, exercise bicycles and hand-powered machines," he says. "We also use free weights and bands. So it's really quite a comprehensive exercise program. People are breaking a sweat and working out."

Beckerman says many people in his Portland, Oregon, program like to track their data points, such as blood pressure, heart rate, fitness test results and weight. But cardiac rehab is not a weight-loss program, he emphasizes. "If you end up losing a couple of pounds in the process, that's great if that's something you needed to do," he says. "But we're not really here in that capacity. We're looking at something even bigger."

For cardiac rehab graduates -- and anyone else interested in heart health -- Beckerman runs the Providence Heart to Start program, where people can learn about his eight-week "exercise prescription" and train for 5K races (as a start).

When it comes to cardiac rehab, he says, there's an emotional and bonding benefit as well. "It helps normalize the idea that your journey is a journey you're making with other people," he says. "On some level, you're all experiencing something that is very common, and you're taking the stigma away from it." The feedback he hears from rehab participants, he says, is "across-the-board awesome."

Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.